Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia (ALL) is a malignant disease that evolves as a result of mutation of lymphoid precursor cells that have their origin in the marrow or thymus, at a particular stage of maturation. The immunophenotype reflects the antigen expression of the stage of differentiation of the dominant clone. The leukemic cells persistently accumulate in intrame- dullary and extramedullary sites, constantly competing with normal hematopoietic cell production and function. This results in...

Pernicious Anemia As A Subset Of Megaloblastic Anemias

Intrinsic factor is the single most important ingredient to the absorption of vitamin B12 and subsequent delivery of vitamin B12 to the circulation. When problems with intrinsic factor develop, the condition is called pernicious anemia. Drs. George Minot and William Murphy of Boston were awarded the Nobel Prize in 1934 for their discovery that ingestion of liver successfully treated patients with pernicious anemia. Several factors may account for the lack of intrinsic factor in the stomach,...

Review Questions

What is the most common presenting symptom in individuals with chronic lymphocytic leukemia 2. What are the peripheral cell indicators of an autoimmune hemolytic anemia in a patient with CLL b. Smudge cells and normal lymphs c. Howell-Jolly bodies and siderocytes d. Lymphoblasts and prolymphocytes 3. A dumbbell-shaped nucleus with fragile, spiny projections like cytoplasm best describes 4. In contrast to most of the other leukemias, which of these conditions presents with a pancytopenia a. CLL...

Condensed Case

A 7-year-old child had a fall from a piece of playground equipment. After 24 hours, he developed a deep hematoma in his right thigh and his parents brought him to the emergency department to be evaluated. His family history did not give any indication of any previous bleeding from birth or otherwise. What tests should be ordered to rule out a coagulation defect Although his family history does not indicate a clotting factor abnormality, preliminary clotting tests should include a bleeding time,...

Case Study

Eight-year-old twin boys were brought into the emergency department with complaints of intermittent fevers and lethargy. The boys had not been feeling well for the last 2 weeks. They had recently returned from a trip to Nigeria with their parents. All members of the family had been treated with antimalarial medication before the trip. Neither parent exhibited any of the symptoms of the children. A CBC with differential was ordered as well as a peripheral smear for malarial parasites. The...

Lymphocyte Origin And Function

The lymphocytic series is distinctive in its presentation and function. In contrast to most other white cells, which are derived solely from the bone marrow, lymphocytes are derived from two locations. The primary lymphoid organs are the bone marrow and thymus. The secondary lymphoid organs are the spleen, lymph nodes, Peyer's patches of the gastrointestinal tract, and the tonsils. Additionally, the lymphatic system plays an essential role in lymphocyte development, differentia- Figure 9.11...

Ineffective Erythropoiesis In Megaloblastic Anemia

The bone marrow is hypercellular in the megaloblastic conditions and the white cell precursor cells are large, especially the metamyelocytes. The myeloid-to-erythroid (M E) ratio is 1 1 or 1 3, reflecting erythroid hyperplasia as you would see in the bone marrow Figure 6.2 Normoblastic erythropoiesis with a polychro-matophilic normoblast (arrow). Figure 6.2 Normoblastic erythropoiesis with a polychro-matophilic normoblast (arrow). Bone marrow destruction of erythroid precursors Lack of...

Manual Reticulocyte Procedure

The reticulocyte count is an index of bone marrow red cell production. The reticulocyte is the cell stage immediately before the mature erythrocyte. This cell spends 2 to 3 days maturing in the bone marrow before it is released into the peripheral circulation, where it spends an additional day of maturation. The reticulocyte count is the most effective measure of erythropoietic activity. Reticulocytes contain RNA and can be observed using supravital stains such as New Methylene Blue or...

LEjCl

Note Page numbers followed by f and t indicate figures and tables, respectively. Acanthocytes, 307 Accuracy precision clarification of, 9, 10f Activated partial thromboplastin time (aPTT), 238 automated procedure for, 315-318 in hemophilia A diagnosis, 260 Activated protein C resistance (Factor V Leiden), 285 laboratory diagnosis, 285-286 pathway, 285f Acute basophilic leukemia, 175 Acute erythroid leukemia, 173-174, 173f Acute hemolytic anemia, 103-104 Acute lymphoblastic leukemia (ALL), 175...

Cerebrospinal Fluidbody Fluid Cell Count And Differential

The examination of the cellular component of body fluids is an important part of total body fluid testing. Cell counts are performed in a counting chamber. Cere-brospinal fluid (CSF), synovial fluids, and serous fluids of the pleural, pericardial, and peritoneal cavities all have characteristic cellular elements, which often change with disease in predictable patterns. Cell counts and cell morphology are key elements in identifying abnormalities within each of these systems. The methods...

Hereditary Spherocytosis

Hereditary Spherocytosis Bone Marrow

The Genetics and Pathophysiology of Hereditary Spherocytosis Hereditary spherocytosis (HS) is a well-studied disorder and fairly common among individuals of northern Figure 7.1 Spherocyte. Note the density of the cell with respect to the other red cells in the background. Figure 7.1 Spherocyte. Note the density of the cell with respect to the other red cells in the background. European origin, with an incidence of 1 5000.1 The mode of inheritance in 75 of individuals is autosomal dominant,...

Infant 1yr

Figure 5.2 Iron need versus amount of recycled iron available. Table 5.5 O Stages of Iron Deficiency Anemia Matched to Diagnostic Signals Stage 1 Iron Stores Depleted. Test for Absence of stainable bone marrow iron Decreased serum ferritin level Increased TIBC Stage 2 Iron-Deficient Erythropoiesis. Test for Slight microcytosis Slight decreased hemoglobin Decreased transferrin saturation Stage 3 Iron Deficiency Anemia. Test for Decreased serum iron Decreased serum ferritin Increased TIBC one of...

O Troubleshooting

What Do I Do When the Lab Results Indicate That the Patient Is Not Responding to Heparin A coagulation sample from the intensive care unit was given to the laboratory on the evening shift. The patient had experienced multiple trauma due to an automobile accident. He had multiple fractures and internal injuries. His condition was grave. Heparin therapy was initiated as a result of the multiple trauma. The patient's admitting PT and aPTT was in the normal range PT 12.0 seconds (11 to 14 seconds)...

Tall

*These are example of chromosome abnormalities the list is not intended to be comprehensive. Figure 11.2 Acute myeloid leukemia with t(8 21) (q22 q22). Note Auer rod in myeloblast. *These are example of chromosome abnormalities the list is not intended to be comprehensive. ence texts for an in-depth discussion of immunophe-notypes and genetics that are characteristic for each disorder. Acute Myeloid Leukemia With t(8 21)(q22 q22) This leukemia occurs most often in children or young adults and...

Glucose6phosphate Dehydrogenase Deficiency

There are a limited number of inherited disorders of red cells related to biochemical deficiencies. Glucoses-phosphate dehydrogenase (G6PD) deficiency represents a fascinating and far-reaching disorder that has at its core a metabolic misstep. G6PD is the catalyst in the first stages of the oxidative portion of the red cell's metabolism and a key player is the phosphogluconate pathway, whose role it is to keep glutathione in the reduced state. Glutathione is the chief red cell antioxidant and...

Polycythemia Vera

PV (polycythemia rubra vera) is a clonal disorder characterized by the overproduction of mature RBCs, WBCs, and platelets.19,20 With the increased production of red cells, there is an increase in hemoglobin, hematocrit, and red cell mass (RCM). Erythrocytosis is the most prominent clinical manifestation of this disorder. The bone marrow is usually hypercellular with hyperplasia of all three bone marrow elements. This disorder usually occurs in the sixth or seventh decade of life. All causes of...

Reticulocyte Procedure With Miller Eye Disc

A Miller Eye Disc is placed inside the microscope eyepiece as an aid to counting reticulocytes. This reticule is a large square inside a small square and provides the technologist the ability to isolate the reticulocytes while counting. 1. New Methylene Blue (Supravital Stain) 4. Microscope with Miller ocular eye disc 1. One EDTA tube or EDTA Microtainer 2. Specimens can be stored at room temperature for 8 hours or refrigerated at 2 to 8 C for 24 hours. Commercially prepared controls are...

Quantitative Disorders Of Platelets

A normal platelet count is 150 to 450 X 109 L. In this range, an individual will have properly functioning platelets that assist in the coagulation process by creating a platelet plug and stimulating the formation of a solid fibrin clot. A decrease in platelet count will cause bleeding from the mucous membranes such as gum bleeding (gingival bleeding), nose bleeding (epistaxis), extensive bruising (ecchymoses), or petechiae (pinpoint hemorrhages). A patient with a platelet count of 60,000 will...

Review Questions fl

Which of the following are defects of platelet adhesion 2. Which one of the conditions will produce a thrombocytopenia due to an altered distribution of platelets 3. One of the main differences between TTP and HUS is d. microangiopathic hemolytic anemia. 4. Nose bleeding, deep bruising, and gum bleeding are usually manifestations of which type of coagulation disorder 5. The presence of thrombocytopenia and giant platelets best describes a. classic von Willebrand's disease. 6. Chronic idiopathic...

Hereditary White Cell Disorders

This inherited disorder is associated with thrombocytopenia and giant platelets. Abnormal bleeding may be seen in a small number of affected individuals. Dohle bodies are seen in the cytoplasm of neutrophils and are larger than the Dohle bodies seen in neutrophils responding to infections or inflammation. Alder's Anomaly (Alder-Reilly Anomaly) This rare genetic disorder is associated with the presence of coarse dark granules in neutrophils, lymphocytes, monocytes, eosinophils, and basophils...

Dohle Bodies Vs Ehrlichiosis In Neutrophils

Toxic Granulation

Figure 10.2 The evolution of toxic granulation. Figure 10.3 Toxic granulation. Note heavier granulation throughout the cytoplasm. Figure 10.3 Toxic granulation. Note heavier granulation throughout the cytoplasm. Normal granulation in the segmented neutrophils shows a dustlike appearance, with the red and blue granules being difficult to observe. Toxic granulation is excessive granulation in amount and intensity, with more prominent granules in segmented neutrophils in direct response to...

Red Blood Cell Membrane Development And Function

The mature red blood cell is a magnificently designed instrument for hemoglobin delivery. As a hemoglobin-filled sac, the red cell travels more than 300 miles through the peripheral circulation, submitting itself to the swift waters of the circulatory system, squeezing itself through the threadlike splenic sinuses, and bathing itself in the plasma microenvironment. Cellular and environmental factors contribute to red cell survival. In order for the red cell to survive for its 120-day life...

Iron Storage And Recycled Iron

Fe2 And Ferritin

Ferritin and hemosiderin are the primary storage forms of iron. These compounds are harbored in the liver, spleen, bone marrow, and skeletal muscle. Ferritin can be measured in plasma, while hemosiderin is more often identified in the urine or stained through the bone marrow. Iron stores in men are generally 1.0 to 1.4 g of body iron, and for women, 0.2 to 0.4 g. Given these figures and with the realization that the iron absorption requirement is on average 1 mg day, it is easy to understand...

Performing A Manual Differential And Assessing Red Blood Cell Morphology

When blood samples are evaluated by the use of automated hematology analyzers, this analysis includes automated differentials. Specific criteria pertaining to normal, abnormal, and critical values have been programmed into the analyzers by the institution, and if the differentials do not meet these criteria, verification is necessary. This is done by performing manual differentials and further evaluating the peripheral smear. First, a differential white blood cell WBC count is performed to...

What Cd Markers Are Seen In Bone Marrow

Stages Lymphoblastic Lymphoma

178 Part III White Cell Disorders In addition to immunophenotype, certain chromosomal alterations have been identified in B-ALL that are considered prognostically important see Table 11-8 . While these abnormalities are not as consistently associated as the Philadelphia chromosome seen in CML, they do provide additional information that can help to refine the treatment regimen. Two abnormalities that have been associated with a good prognosis are 1 hyperploidy greater than 50 and 2 t 12 21 p13...

Reactive Lymphocytosis In Common Disease States

Reactive Lymphocytes Pics

It is normal for young children between the ages of 1 and 4 to have a relative lymphocytosis. The white cell differential in this age group will show a reversal in the number of lymphocytes to segmented neutrophils from the adult reference range. The lymphocytes, however, will have normal morphology Fig. 10.11 . By far the most common disease entity displaying variation in lymphocytes is infectious mononucleosis. This is viral illness caused by the Epstein-Barr virus EBV , a member of the human...

Sickle Cell Procedure Principle

The sickle screen kit provides a procedure based on differential solubility. Hemoglobin S is insoluble when combined with a buffer and a reducing agent. This occurs when the blood is mixed with the buffer and sodium hydrosulfate solution. Specimens containing hemoglobin S are insoluble and show a turbid cloudy solution. Normal adult hemoglobin A is soluble and produces a transparent solution. The presence of hemoglobin S in either the heterozygous or homozygous state will produce a cloudy...

Acute Myeloid Leukemia

AML is malignant, clonal disease that involves proliferation of blasts in bone marrow, blood, or other tissue. The blasts most often show myeloid or monocytic differentiation. Almost 80 of patients with AML will demonstrate chromosome abnormalities, usually a mutation resulting from a chromosomal translocation the transfer of one portion of the chromosome to another .9 The translocation causes abnormal oncogene or tumor suppression gene expression, and this results in unregulated cellular...

The Microscope

The microscope is an essential tool to the hematology laboratory professional. It is a piece of equipment that is stylistically simple in design, yet extraordinarily complex in its ability to magnify an image, provide visual details of that image, and make the image visible to the human eye.2 Most commonly used today are compound microscopes, which use two lens systems to magnify the image. The ocular devices on the microscope provide an initial X10 magnification, and then additional...

Hematological Features Of Megaloblastic Anemias

The CBC shows a pancytopenia low white count, low red count, and low platelet count , although the platelet count may be only borderline low see normal values on the front cover of this textbook . Pancytopenia in the CBC combined with macrocytosis should raise the index of suspicion toward a megaloblastic process because few other conditions aplastic anemia, hyper-splenism show this pattern.4 Red cell inclusions such as basophilic stippling and Howell-Jolly bodies may be observed. Howell-Jolly...

Hematology in Practice

Betty Ciesla

Faculty, Medical Technology Program Morgan State University Baltimore, Maryland Assistant Professor Villa Julie College Stevenson, Maryland F. A. DAVIS COMPANY Philadelphia F A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright 2007 by F. A. Davis Company Copyright 2007 by F A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means,...

Differentiate Extramedullary And Intramedullary Hematopoiesis

Hematopoiesis

Anticoagulant Agent that prevents or delays blood coagulation Pathophysiology Study of how normal processes are Protocols Formal ideas, plan, or scheme concerning patient care, bench work, administration, or research 1. Wintrobe M. Milestones on the path of progress. In Wintrobe M, ed. Blood, Pure and Eloquent. New York McGraw-Hill, 1980 1-27. 2. Abramowitz M. Microscope Basic and Beyond. Vol. 1. Melville, NY Olympus America Inc, 2003 1.25. 3. Wallace MA. Care and use of the microscope. In...